HIV/AIDS and bone health: The role of nutrition

Human immunodeficiency virus (HIV) is a retrovirus that infects immune cells such as CD4+ (helper) T lymphocytes, macrophages and dendritic cells, leading to progressive failure of the immune system. Transmission of HIV can occur through sexual exposure, mother-to-child transmission, injection drug use, transfusion of contaminated blood products, and occupational exposure. The life expectancy of the HIV-positive population has increased; estimates indicate that most HIV-infected persons in the USA will be 50 years or older by 2015. HIV-infected individuals will remain at high risk for osteopenia and osteoporosis, and fractures as their life expectancy increases. This is likely to be an important source of morbidity. Those surviving early-life infection with HIV who initiate treatment at young ages may be especially at risk for adverse effects on bone health. Young men who acquired HIV early in life were reported to have lower peak bone mass by DXA. The etiology of osteoporosis in HIV-infected persons is complex and may involve both HIV disease itself and antiretroviral treatment. Traditional risk factors, such as smoking, hypogonadism, and low body weight, also play a role. Optimal screening and treatment recommendations are not well developed. Due to the higher risk of low BMD compared to HIV-uninfected populations and evidence suggesting higher fracture risk, DXA screening has been recommended by some but not all expert panels for HIV-infected postmenopausal women and men aged 50 years or older, particularly those with additional risk factors. There is a considerable knowledge gap on how best to optimize bone health. Nutritional considerations should be advised; provision of a diet that is rich in vitamin D, especially in areas with limited exposure to sunlight, may also help to ensure the best possible bone growth. HIV-infected individuals, especially children, should also participate in weight-bearing exercises and avoid detrimental behaviors such as smoking to improve their bone health. More research on specific nutritional interventions is needed.